Sun City West narrows Aetna medical renewal to 6.9% after plan design tweaks

Christy Ramirez, senior vice president of client relations at Marsh McLennan, told the Sun City West Budget & Finance Committee that the association’s 2026 medical renewal with Aetna was negotiated down from an initial 12.5% to a net 6.9% increase after modest plan-design changes.

Ramirez said claims through May 2025 formed the basis of the renewal and that May included an unusually costly month with a 373% gross loss ratio in which Aetna paid roughly $793,000 while premiums collected that month were about $212,000. She said the plan retains a pooling point of $125,000 and that three claims exceeded that threshold, including one member with recurring treatments projected to cost an additional $450,000–$500,000.

“As a result of increasing some deductibles and co-pays — primary care to $25, specialist to $50, emergency room to $300 — and narrowing network options, we were able to bring that 9.9% down to 6.9%,” Ramirez said. She outlined three plan options: a high-deductible HSA plan, a performance (narrow-network) plan with a $2,750 deductible, and a broad-PPO buy-up option.

Staff provided enrollment and cost details: 130 employee subscribers (230 members including dependents), an average subscriber age of 52.2, and a total annual premium for rec-center employees of roughly $2.7 million. On a net basis the association’s plan ran at a 120% net claims ratio for the January–May experience period described; Ramirez summarized that target carrier loss ratios are typically 80%–85% on a fully insured basis.

Committee members asked whether family coverage follows the same employer/employee contribution split and whether spouses who could enroll through other employers face surcharges. Ramirez said family tiers follow the same percentage splits used for individual enrollments (employees pay 15% for most tiers; employer contributes roughly 85% on the core plans) and that spousal surcharges can be considered but are not currently in place.

The committee congratulated staff and Marsh McLennan on negotiating a renewal below current market trend projections; members asked staff to continue watching the large ongoing claim and to bring de‑identified, year‑end claims data to future strategic discussions. No formal motion to adopt plan changes was recorded in the meeting minutes.

The committee’s next procedural step is ongoing monitoring and follow‑up with the broker and HR; staff said they will hold post‑renewal strategy meetings and update the committee as additional claims data arrive.